Healthcare Provider Details

I. General information

NPI: 1962700609
Provider Name (Legal Business Name): JOHANNA TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND PARKSIDE METRO OFFICE PARK 14 CALLE 2 SUITE 405
GUAYNABO PR
00968-3313
US

IV. Provider business mailing address

BOX 349 BOSQUE DE LOS PINOS
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-226-5174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17182
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: